HomeMy WebLinkAboutMortgage_Hardiman (10) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION q0-50NIA
/�'' Slate Form 43709(R13110.16) P- prSke 20\gPress bed by Department of Local Govemment Finance �-"^'T\
INSTRUCTIONS: File Mark
To be Wed in person or by mail. Form filed with:
Filing Dates: 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought
Must be Wed or postmarked with the County Auditor or County Recorder of the county where the properly is County Auditor
located on or before January 5 of the immediately succeeding calendar year: County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see on reverse side)
L re
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T strcl Triter/legal Record number Page number
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Assessed value of real property as Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness traitor Is the appgrent the sole
assessment date,current year assessment date,current year date of ppl" legal or equitable owner?
pIt�� O CI 0 No
If no,what is his/her exact share of interest? If owned with other fflan spa me,indicate with whom
If name on record is ddferent than that of applicant,indicate below. .IL J gt)y,/��,ropeny in question:Annually Assessed
I}Y �PaAy ❑ Mobile
1 rI u �,n 1LL6 Mobile Home(IC 6-1.1-7)
"ante of mortgagee a oontrad seller OIA .-� mac. ,JG�n wzEC,21 2018 ` .
Address of mortgagee or contract seller(number and sireet city,state,and ZIP code)
t,,. • .
Name of assignee or other owner or holder of mortgage GIBS6N CGu-r—%
- _
‘1'AUDITOR
Address of assignee(number and sbect city— /
4$ 0/cam.
Does applicant own property in any If yes, - e (y� duchon been requested If yes,state amount of deduction
other in Indiana? ❑yes ❑No ri,1 -O...?I,........ for
❑Yes ❑No
A person is not entitled to this deduction r I)1-:1�Y t '' or contract indebtedness Mat is recorded in the county
recorder's office(including any home equ ice)that is the basis for the deduction.
.?.9 I ri.........
Deducbon approved in the amount ot. Card - o. ..
20 20 20 20 20 - 20' 20
Signature of County Auditor County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owners full Date(month,day,year) r)
X \ -2\- 1
Full� nta Cfappfipnt numb�f and street,dty`sfal and p �) on 1 D
Person authored by duty 33executed Power of Attorney br tiy� IC 6-1..11-11122--O�U.7 y Date(month,day,yeah
Address of authorized person (number and street dry,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.